Fill in this information to identify your case:

Debtor 1 Rosa Angela Lopez

First Name Middle Name Last Name

Debtor 2

(Spouse if, filing) First Name Middle Name Last Name

United States Bankruptcy Court for the: NORTHERN DISTRICT OF ILLINOIS

Case number

(if known)  Check if this an

amended filing

B 103A 

Application for Individuals to Pay the Filing Fee in Installments 12/15

Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct

information.

Part 1: Specify Your Proposed Payment Timetable

1. Which chapter of the Bankruptcy Code are

you choosing to file under?

 Chapter 7

 Chapter 11

 Chapter 12

 Chapter 13

2. You may apply to pay the filing fee in up to

four installments. Fill in the amounts you

propose to pay and the dates you plan to

pay them. Be sure all dates are business

days. Then add the payments you propose

to pay. $ 335.00

 With the filing of the petition

 On or before this date......... 9/15/16

MM / DD/ YYYY

You must propose to pay the entire fee no

later than 120 days after you file this $ On or before this date...........

bankruptcy case. If the court approves your MM / DD/ YYYY

application, the court will set your final $ On or before this date...........

payment timetable. MM / DD/ YYYY

+ $ On or before this date...........

MM / DD/ YYYY

$

335.00

Total Your total must equal the entire fee for the chapter you checked in line 1.

Part 2: Sign Below

By signing here, you state that you are unable to pay the full filing fee at once, that you want to pay the fee in installments, and that you

understand that:

•

You must pay your entire filing fee before you make any more payments or transfer any more property to an attorney, bankruptcy petition

preparer, or anyone else for services in connection with your bankruptcy case.

•

You must pay the entire fee no later than 120 days after you first file for bankruptcy, unless the court later extends your deadline. Your

debts will not be discharged until your entire fee is paid.

•

If you do not make any payment when it is due, your bankruptcy case may be dismissed, and your rights in other bankruptcy proceedings

may be affected.

X /s/ Rosa Angela Lopez X X /s/ S. M. de Rath, Esq.

Rosa Angela Lopez S. M. de Rath, Esq. 6206809

Signature of Debtor 1 Signature of Debtor 2 Your attorney’s name and signature, if you used one

Date July 15, 2016 Date Date July 15, 2016

MM / DD / YYYY MM / DD / YYYY MM/ DD / YYYY

You propose to pay...

B 103A (Official Form 103A) Application for Individuals to Pay the Filing Fee in Installments

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-26259 Doc 2 Filed 08/16/16 Entered 08/16/16 13:15:54 Desc Main

 Document Page 1 of 2
Fill in this information to identify the case:

Debtor 1 Rosa Angela Lopez

First Name Middle Name Last Name

Debtor 2

(Spouse if, filing) First Name Middle Name Last Name

United States Bankruptcy Court for the: NORTHERN DISTRICT OF ILLINOIS

Case number (if known)

Chapter filing under:  Chapter 7

 Chapter 11

 Chapter 12

 Chapter 13

Order Approving Payment of Filing Fee in Installments

After considering the Application for Individuals to Pay the Filing Fee in Installments (Official Form 103A), the court orders

that:

 The debtor(s) may pay the filing fee in installments on the terms proposed in the application.

 The debtor(s) must pay the filing fee according to the following terms:

You must pay... On or before this date...

$

Month / day / year

$

Month / day / year

$

Month / day / year

+ $

Month / day / year

Total $

Until the filing fee is paid in full, the debtor(s) must not make any additional payment or transfer any additional property to

an attorney or to anyone else for services in connection with this case.

By the court:

Month / day / year United States Bankruptcy Judge

B 103A (Official Form 103A) Application for Individuals to Pay the Filing Fee in Installments

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-26259 Doc 2 Filed 08/16/16 Entered 08/16/16 13:15:54 Desc Main

 Document Page 2 of 2